WASHINGTON, D.C. — U.S. Supreme Court review of a divided Seventh Circuit U.S. Court of Appeals panel’s ruling that a federal district court erred in dismissing state and federal False Claims Act (FCA) claims against a health care services provider regarding its alleged operation of a Medicaid billing scheme for reimbursement of skilled nursing facilities (SNF) services is not warranted because the question of whether Federal Rule of Civil Procedure 9(b) “requires plaintiffs in False Claims Act case to plead details of the alleged false claims” is not sufficiently presented, a relator argues in an April 27 opposition brief.
TOPEKA, Kan. — Both a trial court and a state appellate court erred in ruling that Kansas prosecutors failed to sufficiently establish probable cause to exercise territorial jurisdiction over a man charged with insurance fraud and making a false information stemming from his submission of a fraudulent claim for benefits for injuries allegedly sustained in a motor vehicle accident because those courts incorrectly interpreted and applied Kansas law in reaching their decisions, the Kansas Supreme Court ruled April 22 in reversing and remanding.
LAKELAND, Fla. — A Florida appellate panel on April 20 reversed and remanded a state trial court’s grant of summary judgment in favor of a medical care provider that was denied payment of personal injury protection (PIP) benefits due to alleged misrepresentations an insured made in an application for insurance, ruling that an insurer did not violate Florida’s PIP statute by failing to pay or deny the claim within 30 days.
LANSING, Mich. — The Michigan Supreme Court on March 23 agreed to hear an appeal of an automobile insurance dispute in which an appellant seeks a determination whether recession of an automobile insurance policy under the state’s no-fault law bars recovery of noneconomic damages under Michigan law based on the fact that a claimant “did not have in effect . . . the security required” by the no-fault statute “at the time the injury occurred.”
DALLAS — Six laboratories named as defendants in a lawsuit alleging that they were part of a fraudulent billing and illegal kickbacks and referral scheme asked a federal judge in Texas on April 22 to partially reconsider her award of attorneys’ fees sanctions to insurers, arguing that their counsel should not be required to foot part of bill for $11,682.50 in attorney fees sanctions they have been ordered to pay.
JACKSON, Miss. — Claims for bad faith, negligence, recklessness and intentional conduct alleged by insureds seeking coverage for fire damages to their home can proceed because questions of fact exist as to whether the homeowners insurer’s handling of the insureds’ claim was reasonable, a Mississippi federal judge said April 20.
BIRMINGHAM, Ala. — A husband and wife convicted for their roles in an illegal controlled substance distribution and health care fraud scheme asked a federal judge in Alabama on April 19 to grant each of them a new trial, arguing that the evidence presented at trial was prejudicial or insufficient to support the verdicts against them, respectively.
SAN FRANCISCO — A federal district court erred in dismissing a relator’s state and federal False Claims Act claims in a qui tam actions against pharmacies that were alleged to have engaged in a fraudulent scheme to induce public and private insurers to grant prior authorizations for prescriptions because the court required the relator to plead a level of particularity in stating her claims that was extreme and exceeded the level of particularity required pursuant to Federal Rule of Civil Procedure 9(b), the relator argues in an April 18 appellant brief filed in the Ninth Circuit U.S. Court of Appeals.
WASHINGTON, D.C. — The U.S. Supreme Court on April 18 denied a pair of petitions for certiorari filed by law firms that represented a set of relators in qui tam actions stemming from an illegal kickback and referrals scheme allegedly conducted by a group of health care companies and their owners to defraud Medicare and were denied attorney fees under the False Claims Act’s (FCA) first-to-file rule.
ATLANTA — Evidence produced at a trial for a compounding pharmacy’s sales manager was insufficient to sustain her conviction on conspiracy, health care and mail fraud and aggravated identity theft charges stemming from her involvement in a scheme to submit bills to insurance companies for medically unnecessary prescriptions for the compounding pharmacy’s drugs because government prosecutors “failed to prove the requisite mens rea” in pleading its claims against her, the sales manager argues in an April 13 appellant brief filed in the 11th Circuit U.S. Court of Appeals.
BROOKLYN, N.Y. — Voluntarily dismissal of claims against a man alleged to have taken part in a complex scheme to defraud Allstate Insurance Co. and several of its related entities is warranted because the insurers have sufficiently shown that the man will be neither prejudiced nor inconvenienced by dismissing the claims against him, a federal magistrate judge ruled March 29 in recommending that the motion be granted.
ST. THOMAS, Virgin Islands — A federal judge in the Virgin Islands on March 15 entered default judgment in favor of an insurer in a declaratory judgment action seeking a determination that assureds breached their express warranty under the terms of a marine insurance policy, ruling that the policy was null and void at inception because the assureds mispresented in the insurance application that their vessel would be captained only by a covered person and would not be subject to bareboat charters.
ATLANTA — Government prosecutors failed to sufficiently plead their case against a compounding pharmacy’s sales manager on charges that he and others engaged in a scheme to submit bills to insurance companies for medically unnecessary prescriptions for the company’s drugs because prosecutors failed to prove the essential elements of the alleged crime beyond a reasonable doubt and failed to include in the indictment all of the necessary elements of the alleged crime committed, the manager argues in an April 4 appellant brief filed in the 11th Circuit U.S. Court of Appeals.
LAKEWOOD, Fla. — Although a Florida trial court erred in ruling that the deposition testimony of an insurer’s underwriting manager was admissible under the business records exception, the trial court’s grant of summary judgment in favor of the insurer in a lawsuit stemming from a denial of personal injury protection (PIP) benefits based on alleged material misrepresentations made in a policy application was still correct because the manager “was competent to testify from personal knowledge,” a Second District Florida Court of Appeal panel ruled March 30 in affirming.
DALLAS — A federal judge in Texas on April 1 ordered a group of defendant health care clinics and pharmacies and their counsel to pay $11,682.50 in attorney fees sanctions to insurers who allege that the defendants engaged in an insurance fraud scheme to submit fraudulent bills through the use of kickbacks and illegal referrals, ruling that the amount sought is reasonable and in line with Fifth Circuit U.S. Court of Appeals precedent.
SCRANTON, Pa. — A Third Circuit U.S. Court of Appeals panel on April 1 ruled that a federal judge in Pennsylvania did not err in denying a defendants’ motion to suppress the admission of a thumb drive that contained the identifying information of more than 400 people for the purpose of filing federal income tax returns in support of insurance fraud and tax fraud charges against the man because the panel could not determine whether the judge lacked a substantial basis for ruling that probable cause existed to search all of a property connected to the man and the business for which he worked.
WASHINGTON, D.C. — U.S. Supreme Court review of a Sixth Circuit U.S. Court of Appeals’ ruling affirming the dismissal of False Claims Act (FCA) claim and related state law claims brought in a qui tam action against a home health agency and others is not warranted because a relator has asked the Supreme Court to establish “a non-textual exemption from the generally applied heightened pleading standard of Federal Rule of Civil Procedure 9(b)” that does not exist, the respondents argue in an April 1 opposition brief filed in the Supreme Court.
NEWARK, N.J. — A doctor convicted of health care fraud and conspiracy to commit health care fraud in connection with her filing of fraudulent claims to Medicare and private insurance companies is not entitled to a new trial based on testimony submitted by government prosecutors at trial because the conduct alleged in the testimony was “part of the conspiracy alleged” in the conspiracy count against the doctor, federal prosecutors argue in an opposition brief filed March 30 in New Jersey federal court.
PHOENIX — A federal judge in Arizona on March 22 declined to dismiss an alter-ego claim filed by insurers in an insurance fraud dispute alleging that several insureds submitted fraudulent bills for automobile glass repair and replacement services, ruling that the insurers may bring their claim as a theory of liability because it is derivative of, and tied to, other claims brought in the action.
NEW ORLEANS — A federal jury did not err in convicting two men for their roles in a health care fraud scheme to defraud Medicare by certifying patients for home health and hospice services regardless of whether the patients were eligible for such services because evidence provided by government prosecutors was overwhelmingly sufficient to support the guilty verdicts entered against both men, a Fifth Circuit U.S. Court of Appeals panel ruled March 24 in affirming.